Facility Evaluation Report

On 12/4/25, Licensing Program Analyst (LPA) Felisa Shirley arrived at facility to investigate a special incident report received on 12/3/25.

Per the incident report, on 11/29/25, resident was being transferred in a wheelchair from the showers back to their room and while enroute to the room the caregiver tripped and resident fell out of the wheelchair, face first onto the floor.

On 12/4/25, LPA Shirley toured this facility and reviewed resident’s facility file and discharge papers. LPA Shirley interviewed Staff 1 – Staff 3 (S1 – S3), and Resident 1 (R1).

An exit interview was conducted, and a report was left with the Administrator, Susie Fuentes whose signature on this form confirms receipt of this report.